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目的:在急诊介入治疗中,评价预防性冠状动脉(冠脉)内联合注射硝酸甘油和地尔硫(艹卓)对于改善急性 ST 段抬高型心肌梗死(STEMI)心肌微灌注的有效性和安全性。方法:根据是否预防性冠脉注射硝酸甘油和地尔硫(艹卓)将2001年1月至2006年12月在我中心接受急诊冠脉介入治疗的212例 STEMI 患者分为两组,预防性使用上述药物者为研究组(87例),而进行常规介入治疗者为埘照组(125例)。比较两组间基础资料、造影参数、ST 段回落幅度,术后5日心肌生化标记物曲线下面积、左心室射血分数、左心室舒张末内径和随访期间(平均随访17个月)主要心血管病事件的差异。结果:研究组住院及随访期间共计有10例(11.5%)发生主要心血管病事件,对照组为28例(22.4%),两组差异显著(P=0.042);两组因心脏原因再次住院次数差异显著(研究组19.5% vs 对照组37.6%,P=0.008)。研究组的无血流或慢血流发生较对照组少,但未显示出统计学差异,研究组较对照组校正的心肌梗死溶栓治疗临床试验帧数计数(cT-FC)值较低(34.4±11.3 vs 38.9±17.2,P=0.034),心肌微灌注分级(MBG)较高(2.65±0.6 vs 2.41±0.7,P=0.018),提示研究组心肌微灌注优于对照组。研究组较对照组 ST 段回落幅度显著,术后5日心肌生化标记物肌酸激酶同工酶(CK-MB)曲线下面积较小(P<0.05);术后心脏超声左心室射血分数高及舒张末内径较小,均显著优于对照组(P<0.05)。结论:预防性冠脉联合注射硝酸甘油和地尔硫草可改善急性 ST 段抬高型心肌梗死心肌组织微灌注、减少心肌坏死生化标记物的释放、减少近期死亡等主要心血管病事件的发生,改善中、远期临床预后。
OBJECTIVE: To evaluate the efficacy and safety of nitroglycerin and diltiazem combined with prophylactic coronary (coronary) in improving myocardial perfusion in patients with acute ST-elevation myocardial infarction (STEMI) during emergency interventional therapy safety. METHODS: Two hundred and twelve STEMI patients undergoing emergency PCI at our center from January 2001 to December 2006 were divided into two groups according to whether prophylactic coronary perfusion with nitroglycerin and diltiazem (propranolol) Those who used the above-mentioned drugs were the study group (87 cases), while those who underwent routine intervention were the control group (125 cases). Baseline data, contrast parameters, ST-segment regression, area under the curve of myocardial biochemical markers on the 5th postoperative day, left ventricular ejection fraction, left ventricular end-diastolic diameter and follow-up period were compared between two groups (mean follow-up of 17 months) Differences in vascular events. Results: During the hospitalization and follow-up periods, a total of 10 cardiovascular events (11.5%) occurred in the study group compared with 28 (22.4%) in the control group, with significant differences between the two groups (P = 0.042) The number of differences was significant (study group 19.5% vs control group 37.6%, P = 0.008). The study group had fewer or no blood flow or slow blood flow compared with the control group, but did not show any significant difference. The cT-FC values of the study group were lower than those of the control group in the myocardial infarction thrombolytic therapy trial 34.4 ± 11.3 vs 38.9 ± 17.2, P = 0.034). Myocardial microperfusion perfusion (MBG) was higher (2.65 ± 0.6 vs 2.41 ± 0.7, P = 0.018), which suggested that myocardial perfusion in study group was better than that in control group. The ST-segment decline rate of the study group was significantly higher than that of the control group, and the area under the CK-MB curve of myocardial biochemical markers was lower on the 5th postoperative day (P <0.05). The postoperative left ventricular ejection fraction High and end diastolic diameter smaller, were significantly better than the control group (P <0.05). CONCLUSION: Preventive coronary perfusion with nitroglycerin and diltiazem improves myocardial perfusion in acute ST-segment elevation myocardial infarction, decreases the release of biochemical markers of myocardial necrosis, and reduces the occurrence of major cardiovascular events such as recent death , To improve the long-term clinical prognosis.